The document discusses menstrual cycle disorders, specifically amenorrhea and oligomenorrhea, which can lead to absent or irregular periods. It highlights the importance of consulting a healthcare provider if a woman misses more than three menstrual periods, as these conditions can indicate underlying health issues. The evaluation process for irregular periods includes a detailed medical history, physical examination, hormone testing, and potentially imaging studies to identify any abnormalities.

1. Are You Suffering from Irregular
Periods?
Absent or irregular periods??

2. Menstrual cycle disorders can cause a woman’s periods to be absent or
infrequent. Although some women do not mind missing their
menstrual period, these changes should always be discussed with a
healthcare provider because they can signal underlying medical
conditions and potentially have long-term health consequences. A
woman who misses more than three menstrual periods (either
consecutively or over the course of a year) should see a healthcare
provider.

3. 1. Amenorrhea - Amenorrhea refers to the absence of menstrual periods,
and is classified as either:
• Primary (when menstrual periods have not started by age 15).
• Secondary (when menstrual periods are absent for more than three to
six months in a woman who previously had periods).
2. Oligomenorrhea - Oligomenorrhea is the medical term for infrequent
menstrual periods (fewer than six to eight periods per year).
The causes, evaluation, and treatment of amenorrhea and oligomenorrhea
are similar and will be discussed together.

4. CAUSES OF IRREGULAR PERIODS
• The brain (including the hypothalamus and pituitary gland), ovaries,
and uterus normally follow a sequence of events once per month that
helps to prepare the body for pregnancy. Two hormones, Follicle
Stimulating Hormone (FSH) and Luteinizing hormone (LH), are made
by the pituitary gland. Two other hormones, progesterone and
estrogen, are made by the ovaries.
• Menstrual cycle disorders can result from conditions that affect the
hypothalamus, pituitary gland, ovaries, uterus, cervix, or vagina.

5. Primary amenorrhea
Some of the more common causes of primary amenorrhea include the following:
• Conditions that are present at birth, but may not be noticed until puberty.
These conditions include genetic or chromosomal abnormalities and
abnormalities of the reproductive organs (e.g., if the uterus is not present or
developed abnormally).
• All of the conditions that lead to secondary amenorrhea can also cause
primary amenorrhea.

6. Secondary amenorrhea
Pregnancy is the most common of secondary amenorrhea. Other common causes include the
following:
• Ovarian conditions, such as polycystic ovary syndrome and ovarian insufficiency (early
menopause).
• Hypothalamic amenorrhea. This occurs when the hypothalamus slows or stops releasing
GnRH (gonadotropin releasing hormone),a hormone that influences when a woman has a
menstrual period.
•Hypothalamic amenorrhea is associated with low body weight (defined as weighing 10
percent below ideal body weight), a low percentage of body fat, eating disorders such as
anorexia nervosa or bulimia nervous, emotional stress, strenuous exercise, and some medical
conditions or illnesses. However, in some cases, there is no obvious explanation for
hypothalamic amenorrhea.
• Prolactin-secreting pituitary tumors are another common cause of secondary amenorrhea.
Oligomenorrhea — Many of the conditions that cause primary or secondary amenorrhea can
also cause a woman to ovulate irregularly). However, most women who develop infrequent
periods have polycystic ovary syndrome.

7. EVALUATION OF IRREGULAR
PERIODSThe evaluation of amenorrhea/ oligomenorrhea includes a complete medical history and physical examination.
•History — There are often clues about the cause of amenorrhea in a woman’s personal and family medical
history. A woman should mention if she had any health problems during infancy or childhood, when her first
period started (if there was a first period) and how frequently periods have occurred since. If known, the
woman should also mention if there is any family history of irregular menstrual periods.
•Other important points include the presence of discharge from the breasts, hot flashes, adult acne, facial or
chest hair, and headaches or impaired vision. The clinician will also ask about any medications, herbs, and
vitamins used, recent stress, recent gynecologic procedures, changes in weight, diet, or exercise patterns, and
illnesses.
•Physical examination — During the physical examination, the provider will examine the face, neck, breasts,
and abdomen. A pelvic examination will also be performed.
•Testing — Depending upon the individual, the clinician may order blood tests. Because pregnancy is the most
common cause of secondary amenorrhea, a pregnancy test is usually recommended for women whose
menstrual periods have stopped. Blood tests to measure hormone levels will also be ordered.
•In selected cases, a magnetic resonance imaging (MRI) test may be done to determine if there are
hypothalamic or pituitary gland abnormalities in the brain. Occasionally, in women with a suspected
chromosomal abnormality, a chromosome analysis may be recommended. A pelvic ultrasound may be
recommended to identify abnormalities of the uterus, cervix, and vagina.
•For more information , Read PCOS